ORIGINAL ARTICLE A comparison between IVIG and plasma exchange as preparations before thymectomy in myasthenia gravis patients Athena Alipour-Faz 1 • Maziar Shojaei 2 • Hassan Peyvandi 3 • Davood Ramzi 1 • Mahbobeh Oroei 4 • Fereshteh Ghadiri 2 • Maryam Peyvandi 1 Received: 15 March 2016 / Accepted: 5 August 2016 Ó Belgian Neurological Society 2016 Abstract Myasthenia gravis (MG) is one of the curable neurologic disorders. Various pharmacological therapies are administered for these patients and a thymectomy plays an important role in the therapy of myasthenia gravis, which develops a permanent or relative remission. We investigated the efficacy of intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) as a preparation before thymectomy in patients with MG. This randomized clinical trial was conducted on 24 patients with MG referred for thymectomy, which were randomized to two groups of IVIG and PLEX. The IVIG group received IVIG 1 g/kg/day for two consecutive days and the PLEX group underwent 1-L plasma exchange five times with 5 % albumin replacement fluid, every other day, 10–30 days before the procedure. The duration of hospitalization (day), length of intensive care unit (ICU) stay after surgery (day), length of intubation period (h), duration of surgery (h) and dose of steroid administered were compared between the two groups. Analysis was performed via SPSS version 20. In the PLEX group, post-operative outcomes (duration of hospitalization, ICU length of stay after surgery, intubation period and duration of surgery) were longer than those in the IVIG group. There was significant difference in intu- bation period (p value = 0.01) and duration of surgery (p value = 0.05) between the PLEX and IVIG groups. The administration of IVIG in comparison to PLEX can be more effective in the preparation before thymectomy in myasthenia gravis patients. Keywords Intravenous immunoglobulin Á Plasma exchange Á Myasthenia gravis Á Thymectomy Introduction Myasthenia gravis (MG) is a relatively rare autoimmune disorder in children and adults, so the prevalence rate is estimated at 0.5–20.4 patients per 100,000 persons [1]. This disorder is caused by autoantibodies against nicotinic acetylcholine postsynaptic receptors at the neuromuscular junction of the skeletal muscles or the muscle-specific tyrosine kinase in most patients [2]. The anti-acetylcholine receptor antibody damages the postsynaptic membrane and induces reduction in the number of acetylcholine receptors [3]. Myasthenia gravis is a heterogenous disorder in which any voluntary muscle may be involved. There is a pattern of progressive reduction in muscular strength due to repeated use that will improve after resting [4]. The most common affected muscles include the extrinsic ocular muscles, causing eyelid ptosis and diplopia with fluctuating generalized weakness [5]. The incidence rate of MG has increased in the recent decades and 30 patients per 1 million people have been reported. This change can be related to increasing life expectancy in persons and improved methods of diagnosis & Hassan Peyvandi hassan.peyvandi@gmail.com 1 Researcher, Clinical Research Development Center of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2 Department of Neurology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3 Associate Professor of General Surgery, Hearing Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 4 Community Medicine, Clinical Research Development Center of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 123 Acta Neurol Belg DOI 10.1007/s13760-016-0689-z